|
ROOM/BED: Extended Recovery
|
Facility
IP
|
$50.00
|
|
| Hospital Charge Code |
2091602
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$45.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$8.50
|
| Rate for Payer: Amerigroup Medicare |
$8.50
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$8.50
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$8.50
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$13.00
|
| Rate for Payer: Copperpoint |
$14.03
|
| Rate for Payer: Humana Medicare |
$8.50
|
| Rate for Payer: SELF PAY |
$40.00
|
| Rate for Payer: Veterans (Triwest) |
$8.50
|
|
|
ROOM/BED: Observation
|
Facility
OP
|
$106.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1101857
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$95.40
|
| Rate for Payer: Aetna Medicare |
$29.68
|
| Rate for Payer: AHCCCS Medicaid |
$60.00
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$60.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.02
|
| Rate for Payer: Amerigroup Medicare |
$18.02
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$39.59
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$60.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.02
|
| Rate for Payer: Banner University Family Care Medicaid |
$60.00
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$69.94
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.56
|
| Rate for Payer: Cigna All Products |
$74.20
|
| Rate for Payer: Copperpoint |
$29.73
|
| Rate for Payer: HealthNet Commercial |
$63.60
|
| Rate for Payer: HealthNet Medicare |
$29.68
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Mercy Care Medicaid |
$60.00
|
| Rate for Payer: SELF PAY |
$84.80
|
| Rate for Payer: Veterans (Triwest) |
$18.02
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$61.80
|
| Rate for Payer: United Healthcare Medicare |
$19.08
|
|
|
ROOM/BED: Observation
|
Facility
IP
|
$106.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
1101857
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna POS, PPO, HMO |
$95.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$18.02
|
| Rate for Payer: Amerigroup Medicare |
$18.02
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$18.02
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$69.94
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$27.56
|
| Rate for Payer: Copperpoint |
$29.73
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: SELF PAY |
$84.80
|
| Rate for Payer: Veterans (Triwest) |
$18.02
|
|
|
ROOM/BED: Semi Private
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
867361
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,080.00
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$204.00
|
| Rate for Payer: Amerigroup Medicare |
$204.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$448.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$204.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$204.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$312.00
|
| Rate for Payer: Cigna All Products |
$840.00
|
| Rate for Payer: Copperpoint |
$336.60
|
| Rate for Payer: HealthNet Commercial |
$720.00
|
| Rate for Payer: HealthNet Medicare |
$336.00
|
| Rate for Payer: Humana Medicare |
$204.00
|
| Rate for Payer: SELF PAY |
$960.00
|
| Rate for Payer: Veterans (Triwest) |
$204.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$699.60
|
| Rate for Payer: United Healthcare Medicare |
$216.00
|
|
|
ROOM/BED: Semi Private
|
Facility
IP
|
$1,200.00
|
|
| Hospital Charge Code |
867361
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,080.00
|
| Rate for Payer: Aetna Medicare |
$1,263.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$204.00
|
| Rate for Payer: Amerigroup Medicare |
$204.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,022.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$204.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$204.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$312.00
|
| Rate for Payer: Cigna All Products |
$1,700.00
|
| Rate for Payer: Copperpoint |
$336.60
|
| Rate for Payer: HealthNet Commercial |
$1,231.00
|
| Rate for Payer: HealthNet Medicare |
$1,176.00
|
| Rate for Payer: Humana Medicare |
$204.00
|
| Rate for Payer: SELF PAY |
$960.00
|
| Rate for Payer: Veterans (Triwest) |
$204.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,434.00
|
| Rate for Payer: United Healthcare Medicare |
$1,751.00
|
|
|
ROOM/BED: Swingbed
|
Facility
IP
|
$1,200.00
|
|
| Hospital Charge Code |
11805353
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,080.00
|
| Rate for Payer: Aetna Medicare |
$1,263.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$204.00
|
| Rate for Payer: Amerigroup Medicare |
$204.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,022.00
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$204.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$204.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$312.00
|
| Rate for Payer: Cigna All Products |
$1,700.00
|
| Rate for Payer: Copperpoint |
$336.60
|
| Rate for Payer: HealthNet Commercial |
$1,231.00
|
| Rate for Payer: HealthNet Medicare |
$1,176.00
|
| Rate for Payer: Humana Medicare |
$204.00
|
| Rate for Payer: SELF PAY |
$960.00
|
| Rate for Payer: Veterans (Triwest) |
$204.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,434.00
|
| Rate for Payer: United Healthcare Medicare |
$1,751.00
|
|
|
ROOM/BED: Swingbed
|
Facility
OP
|
$1,200.00
|
|
| Hospital Charge Code |
11805353
|
|
Hospital Revenue Code
|
120
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$1,080.00
|
| Rate for Payer: Aetna Medicare |
$336.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$204.00
|
| Rate for Payer: Amerigroup Medicare |
$204.00
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$448.20
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$204.00
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$204.00
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$312.00
|
| Rate for Payer: Cigna All Products |
$840.00
|
| Rate for Payer: Copperpoint |
$336.60
|
| Rate for Payer: HealthNet Commercial |
$720.00
|
| Rate for Payer: HealthNet Medicare |
$336.00
|
| Rate for Payer: Humana Medicare |
$204.00
|
| Rate for Payer: SELF PAY |
$960.00
|
| Rate for Payer: Veterans (Triwest) |
$204.00
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$699.60
|
| Rate for Payer: United Healthcare Medicare |
$216.00
|
|
|
Rotatable Small Oval Snare Medium Stiffness
|
Facility
OP
|
$203.00
|
|
| Hospital Charge Code |
22926473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$182.70
|
| Rate for Payer: Aetna Medicare |
$56.84
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.51
|
| Rate for Payer: Amerigroup Medicare |
$34.51
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$75.82
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.51
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.51
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$52.78
|
| Rate for Payer: Cigna All Products |
$142.10
|
| Rate for Payer: Copperpoint |
$56.94
|
| Rate for Payer: HealthNet Commercial |
$121.80
|
| Rate for Payer: HealthNet Medicare |
$56.84
|
| Rate for Payer: Humana Medicare |
$34.51
|
| Rate for Payer: SELF PAY |
$162.40
|
| Rate for Payer: Veterans (Triwest) |
$34.51
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$118.35
|
| Rate for Payer: United Healthcare Medicare |
$36.54
|
|
|
Rotatable Small Oval Snare Medium Stiffness
|
Facility
IP
|
$203.00
|
|
| Hospital Charge Code |
22926473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$182.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$182.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$34.51
|
| Rate for Payer: Amerigroup Medicare |
$34.51
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$34.51
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$34.51
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$52.78
|
| Rate for Payer: Copperpoint |
$56.94
|
| Rate for Payer: Humana Medicare |
$34.51
|
| Rate for Payer: SELF PAY |
$162.40
|
| Rate for Payer: Veterans (Triwest) |
$34.51
|
|
|
ROTH NET
|
Facility
IP
|
$440.00
|
|
| Hospital Charge Code |
22354323
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$396.00
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$74.80
|
| Rate for Payer: Amerigroup Medicare |
$74.80
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$74.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$74.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$114.40
|
| Rate for Payer: Copperpoint |
$123.42
|
| Rate for Payer: Humana Medicare |
$74.80
|
| Rate for Payer: SELF PAY |
$352.00
|
| Rate for Payer: Veterans (Triwest) |
$74.80
|
|
|
ROTH NET
|
Facility
OP
|
$440.00
|
|
| Hospital Charge Code |
22354323
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna POS, PPO, HMO |
$396.00
|
| Rate for Payer: Aetna Medicare |
$123.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$74.80
|
| Rate for Payer: Amerigroup Medicare |
$74.80
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$164.34
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$74.80
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$74.80
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$114.40
|
| Rate for Payer: Cigna All Products |
$308.00
|
| Rate for Payer: Copperpoint |
$123.42
|
| Rate for Payer: HealthNet Commercial |
$264.00
|
| Rate for Payer: HealthNet Medicare |
$123.20
|
| Rate for Payer: Humana Medicare |
$74.80
|
| Rate for Payer: SELF PAY |
$352.00
|
| Rate for Payer: Veterans (Triwest) |
$74.80
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$256.52
|
| Rate for Payer: United Healthcare Medicare |
$79.20
|
|
|
RPR LC
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2269415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: AHCCCS Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$24.28
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.27
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Cigna All Products |
$42.25
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: HealthNet Commercial |
$39.00
|
| Rate for Payer: HealthNet Medicare |
$18.20
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Mercy Care Medicaid |
$4.27
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$37.89
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
|
|
RPR LC
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
2269415
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
|
|
.RPR Qn+TP Abs LC
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
22311166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
|
|
.RPR Qn+TP Abs LC
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
22311166
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: AHCCCS Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$24.28
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.27
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Cigna All Products |
$42.25
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: HealthNet Commercial |
$39.00
|
| Rate for Payer: HealthNet Medicare |
$18.20
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Mercy Care Medicaid |
$4.27
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$37.89
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
|
|
.RPR, Quant LC
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
3033479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
|
|
.RPR, Quant LC
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
3033479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: AHCCCS Medicaid |
$4.40
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.40
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$24.28
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.40
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.40
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Cigna All Products |
$42.25
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: HealthNet Commercial |
$39.00
|
| Rate for Payer: HealthNet Medicare |
$18.20
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Mercy Care Medicaid |
$4.40
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$37.89
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
|
|
RPR, Rfx Qn RPR/Confirm TP LC
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
22201655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
|
|
RPR, Rfx Qn RPR/Confirm TP LC
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
22201655
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna POS, PPO, HMO |
$58.50
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: AHCCCS Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$4.27
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$11.05
|
| Rate for Payer: Amerigroup Medicare |
$11.05
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$24.28
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$4.27
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$11.05
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$11.05
|
| Rate for Payer: Banner University Family Care Medicaid |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield AZ PPO |
$42.16
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$16.90
|
| Rate for Payer: Cigna All Products |
$42.25
|
| Rate for Payer: Copperpoint |
$18.23
|
| Rate for Payer: HealthNet Commercial |
$39.00
|
| Rate for Payer: HealthNet Medicare |
$18.20
|
| Rate for Payer: Humana Medicare |
$11.05
|
| Rate for Payer: Mercy Care Medicaid |
$4.27
|
| Rate for Payer: SELF PAY |
$52.00
|
| Rate for Payer: Veterans (Triwest) |
$11.05
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$37.89
|
| Rate for Payer: United Healthcare Medicare |
$11.70
|
|
|
RT Continuous Neb Subsequent Charge
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
3230232
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$255.60
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.28
|
| Rate for Payer: Amerigroup Medicare |
$48.28
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.28
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$73.84
|
| Rate for Payer: Copperpoint |
$79.66
|
| Rate for Payer: Humana Medicare |
$48.28
|
| Rate for Payer: SELF PAY |
$227.20
|
| Rate for Payer: Veterans (Triwest) |
$48.28
|
|
|
RT Continuous Neb Subsequent Charge
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
3230232
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$48.28 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna POS, PPO, HMO |
$255.60
|
| Rate for Payer: Aetna Medicare |
$79.52
|
| Rate for Payer: AHCCCS Medicaid |
$95.74
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$95.74
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$48.28
|
| Rate for Payer: Amerigroup Medicare |
$48.28
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$106.07
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$95.74
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$48.28
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$48.28
|
| Rate for Payer: Banner University Family Care Medicaid |
$95.74
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$73.84
|
| Rate for Payer: Cigna All Products |
$198.80
|
| Rate for Payer: Copperpoint |
$79.66
|
| Rate for Payer: HealthNet Commercial |
$170.40
|
| Rate for Payer: HealthNet Medicare |
$79.52
|
| Rate for Payer: Humana Medicare |
$48.28
|
| Rate for Payer: Mercy Care Medicaid |
$95.74
|
| Rate for Payer: SELF PAY |
$227.20
|
| Rate for Payer: Veterans (Triwest) |
$48.28
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$165.57
|
| Rate for Payer: United Healthcare Medicare |
$51.12
|
|
|
RT ETC02 Monitoring Charge
|
Facility
OP
|
$683.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
1886873
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$116.11 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$614.70
|
| Rate for Payer: Aetna Medicare |
$191.24
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$116.11
|
| Rate for Payer: Amerigroup Medicare |
$116.11
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$255.10
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$116.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$116.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$177.58
|
| Rate for Payer: Cigna All Products |
$478.10
|
| Rate for Payer: Copperpoint |
$191.58
|
| Rate for Payer: HealthNet Commercial |
$409.80
|
| Rate for Payer: HealthNet Medicare |
$191.24
|
| Rate for Payer: Humana Medicare |
$116.11
|
| Rate for Payer: SELF PAY |
$546.40
|
| Rate for Payer: Veterans (Triwest) |
$116.11
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$398.19
|
| Rate for Payer: United Healthcare Medicare |
$122.94
|
|
|
RT ETC02 Monitoring Charge
|
Facility
IP
|
$683.00
|
|
|
Service Code
|
CPT G0238
|
| Hospital Charge Code |
1886873
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$116.11 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Aetna POS, PPO, HMO |
$614.70
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$116.11
|
| Rate for Payer: Amerigroup Medicare |
$116.11
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$116.11
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$116.11
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$177.58
|
| Rate for Payer: Copperpoint |
$191.58
|
| Rate for Payer: Humana Medicare |
$116.11
|
| Rate for Payer: SELF PAY |
$546.40
|
| Rate for Payer: Veterans (Triwest) |
$116.11
|
|
|
RT Ventilator Services - Subs Charge
|
Facility
OP
|
$2,858.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
1886948
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$485.86 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,572.20
|
| Rate for Payer: Aetna Medicare |
$800.24
|
| Rate for Payer: AHCCCS Medicaid |
$703.62
|
| Rate for Payer: Allwell from Arizona Medicaid by Arizona Complete Health Medicaid |
$703.62
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$485.86
|
| Rate for Payer: Amerigroup Medicare |
$485.86
|
| Rate for Payer: Arizona Physicians IPA (APIPA) Medicare and Medicaid |
$1,067.46
|
| Rate for Payer: Arizona Complete Care Health Medicaid |
$703.62
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$485.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$485.86
|
| Rate for Payer: Banner University Family Care Medicaid |
$703.62
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$743.08
|
| Rate for Payer: Cigna All Products |
$2,000.60
|
| Rate for Payer: Copperpoint |
$801.67
|
| Rate for Payer: HealthNet Commercial |
$1,714.80
|
| Rate for Payer: HealthNet Medicare |
$800.24
|
| Rate for Payer: Humana Medicare |
$485.86
|
| Rate for Payer: Mercy Care Medicaid |
$703.62
|
| Rate for Payer: SELF PAY |
$2,286.40
|
| Rate for Payer: Veterans (Triwest) |
$485.86
|
| Rate for Payer: United Healthcare (PPO, HMO, HMO, POS) |
$1,666.21
|
| Rate for Payer: United Healthcare Medicare |
$514.44
|
|
|
RT Ventilator Services - Subs Charge
|
Facility
IP
|
$2,858.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
1886948
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$485.86 |
| Max. Negotiated Rate |
$2,572.20 |
| Rate for Payer: Aetna POS, PPO, HMO |
$2,572.20
|
| Rate for Payer: Allwell from Arizona Complete Health Medicare Advantage |
$485.86
|
| Rate for Payer: Amerigroup Medicare |
$485.86
|
| Rate for Payer: Arizona Complete Care Health Medicare Advantage |
$485.86
|
| Rate for Payer: Banner University Care Advantage Health Maintenance Organization |
$485.86
|
| Rate for Payer: City of Bisbee Police Bisbee Police |
$743.08
|
| Rate for Payer: Copperpoint |
$801.67
|
| Rate for Payer: Humana Medicare |
$485.86
|
| Rate for Payer: SELF PAY |
$2,286.40
|
| Rate for Payer: Veterans (Triwest) |
$485.86
|
|